Abstract
Introduction The studyʼs objectives were to determine the success rate following radiofrequency
endometrial ablation to treat abnormal menstrual bleeding and to assess risk factors
for failure of the method.
Materials and Methods 195 women who were treated with bipolar radiofrequency endometrial ablation between
01/2009 and 06/2016 were included in this prospective cohort study. Postoperative
data from 187 women were collected at a median of 17.5 months (IQR 4.5–34.9; 1–82).
Multivariate analyses of risk factors were performed. Success was defined as amenorrhoea
or spotting.
Results Patient characteristics were as follows: mean age 44 years (SD ± 5), median parity
2 (IQR 2–3), median hysterometer 8.7 cm (SD ± 1.1), and median BMI 23.5 kg/m2 (IQR 21–27). 30 patients (19.5%) had intramural masses that could be measured with
ultrasound. Postoperative success rate was 86.1%. 10 patients (5%) had a hysterectomy
postoperatively – 6 for heavy bleeding, 3 due to prolapse, and 1 due to dysmenorrhoea.
Multivariate analyses showed the presence of intramural masses in women < 45 years
was a significant risk factor for therapeutic failure (p = 0.033; 95% CI 1.08–12.57),
with an increased risk of hysterectomy (OR 7.9, 95% CI 1.2–52.7, p = 0.033).
Conclusion Bipolar radio frequency endometrial ablation was highly successful in the absence
of an intramural mass (88%). Even smaller intramural fibroids (DD: adenomyomas of
a median of 15 mm) reduce the success rate (76%), which is why preoperative ultrasound
is recommended. In the presence of intramural masses, the risk of a hysterectomy for
women < 45 years increases eightfold.
Key words
radiofrequency endometrial ablation - hypermenorrhea - menorrhagia - fibroids
